Implementation and Evaluation of a Team-Based Approach to Hospital Discharge Transition of Care

Background: Transitional care management (TCM) programs guide patients from hospital discharge to outpatient follow-up with the goal to decrease hospital readmissions and the cost of care. In 2017, the department of primary care internal medicine (PCIM) at Eastern Virginia Medical Group implemented TCM. We aimed to evaluate the efficacy and self-sustainability of this TCM program. Methods: The TCM team contacted patients upon discharge to schedule the follow-up appointment. We coded patient contact as (1) no successful phone-call contact, patient did not attend appointment; (2) successful phone-call contact, patient did not attend appointment; and (3) patient attended appointment. We collected patient demographics, readmissions, and visit costs using manual chart review and electronic health record (EHR) data extraction. We conducted χ2 analysis, one-way analysis of variance, and unpaired t tests to assess associations between readmission rates or costs and TCM care. Results: Initial analysis did not indicate significant associations between readmission rates and level of TCM care at 30 (χ2=1.40, P=.50), 60 (χ2=5.48, P=.06), or 90 (χ2=4.23, P=.12) days or significant differences in patient charges at 30 (F[2,59]=2.85, P=.06), 60 (F[2,91]=2.00, P=.14), or 90 (F[2,126]=1.39, P=.25) days. Follow-up analysis indicated significant associations between readmission rates and any level of TCM care at 60 (χ2=5.40, P=.02) and 90 (χ2=4.21, P=.04) days, but not at 30 days (χ2=1.39, P=.28). Conclusions: Our TCM program review suggests that the benefits of transitional care extend beyond 30 days by decreasing readmission rates at 60 and 90 days after hospital discharge.

Discharge transition experienced by older Korean women after hip fracture surgery: a qualitative study

Background This study aimed to explore older Korean women’s discharge transition experiences after hip fracture surgery. Methods This was a descriptive qualitative study. Face-to-face interviews following hip fracture surgery were conducted on 12 women aged 65–87 years. Data were collected 1 to 2 days before discharge and again 4 weeks after discharge following hip fracture surgery, and were analyzed using qualitative content analysis. Results Four main themes were identified: (1) challenge of discharge transition: unprepared discharge, transfer into other care settings, and eagerness for recovery; (2) physical and psychological distress against recovery: frail physical state and psychological difficulties; (3) dependent compliance: absolute trust in healthcare providers, indispensable support from the family, and passive participation in care; and (4) walking for things they took for granted: hope of walking and poor walking ability. Conclusions After their hip fracture surgeries, older women hoped to be able to walk and perform simple daily chores they previously took for granted. Considering the physical and psychological frailty of older women undergoing hip surgery, systematic nursing interventions including collaboration and coordination with other healthcare professionals and settings are necessary to ensure the quality of continuous care during their post-surgery discharge transition. Encouraging partial weight bearing and initiating intervention to reduce fear of falling at the earliest possible time are essential to attain a stable discharge transition. Additionally, older women should be invited to participate in their care, and family involvement should be encouraged during the discharge transition period in South Korea.

Особенности инициирования эффекта полого катода в электродной системе тлеющего разряда с протяженной катодной щелью

The influence of the size of the cathode gap on the initiation of the hollow cathode effect in a glow discharge system with an extended rectangular hollow cathode is presented. It is established that the threshold current of the discharge transition to the mode with a hollow cathode is determined by the size of the cathode gap. With a decrease in the width of the gap, the threshold current increases disproportionately, with an increase in the longitudinal size of the gap, this current decreases sharply

Discharge Transition Experienced by Korean Older Adults After Hip Fracture Surgery: A Qualitative Study

Background: This study aimed to explore Korean older adults’ experience with discharge transition after hip fracture surgery. Methods: This was a descriptive qualitative study. Face-to-face interviews following hip fracture surgery were conducted with 12 participants. Data were collected one to two days before discharge and again four weeks after discharge following hip fracture surgery, and were analyzed using qualitative content analysis.Results: Four main themes were identified: (1) Challenge of discharge transition: unprepared discharge, transfer into other care settings, and eagerness for recovery; (2) Physical and psychological distress against recovery: frail physical state and psychological difficulties; (3) Dependent compliance: absolute trust in healthcare providers, indispensable support from the family, and passive participation in care; and (4) Walking for things they took for granted: hope of walking and poor walking ability.Conclusions: After the hip fracture surgery, older adults hoped to be able to walk to perform the simple daily chores they earlier took for granted. Considering the physical and psychological frailty of older adults, systematic nursing interventions, including collaboration and coordination with other healthcare professional and settings, are necessary during discharge transition after hip fracture surgery. Invitation for care participation by older adults as well as family involvement should be considered at discharge transitional care in South Korea.

ECHO-CT: An Interdisciplinary Video-Conference Model for Identifying Post-Discharge Transition-of-Care Events

Introduction: Discharge from the hospital to a post-acute care setting can be complex and potentially dangerous, with opportunities for errors and lapses in communication between providers. Data collected through the Extension for Community Health Outcomes-Care Transitions (ECHO-CT) model were used to identify and classify transitional care events (TCEs.) Methods: The ECHO-CT model employs multidisciplinary teleconferences between a hospital-based team and providers in post-acute settings; during this conference, concerns arising in the patient’s care transition were identified and recorded. Results: 675 patients were discussed during interdisciplinary videoconferences. A total of 139 TCEs were identified; 52 (37.4%) were classified as medication issues, and 58 (41.7%) involved discharge communication or coordination errors. Conclusions: These identified TCEs highlight areas in which providers can work to reduce issues arising in the course of discharge to post-acute facilities. Standardized processes to identify, record, and report transition of care events are necessary to provide high-quality, safe care for patients as they move across care settings.

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

Background The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. Methods This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student’s t-test, χ2-test or Fishers’ exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. Results The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). Conclusion Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.

The Adaptation and Validation of the Satisfaction with Stroke Care Questionnaire (Homesat) (SASC10-MyTM) for use in public primary healthcare facilities caring for long- term stroke survivors residing at home in the community.

Background Satisfaction with post stroke services would assist stakeholders in addressing gaps in service delivery. Tools used to evaluate satisfaction with stroke care services need to be validated to match healthcare services provided in each country. Studies on satisfaction with post discharge stroke care delivery in low- and middle-income countries (LMIC) are scarce, despite knowledge that post stroke care delivery is fragmented and poorly coordinated. This study aims to modify and validate the HomeSat subscale of the Dutch Satisfaction with Stroke Care-19 (SASC-19) questionnaire for use in Malaysia and in countries with similar public healthcare services in the region.Methods The HomeSat subscale of the Dutch SASC-19 questionnaire (11 items) underwent back-to-back translation to produce a Malay language version. Content validation was done by Family Medicine Specialists involved in community post-stroke care. Community social support services in the original questionnaire were substituted with equivalent local services to ensure contextual relevance. Internal consistency reliability was determined using Cronbach alpha. Exploratory factor analysis was done to validate the factor structure of the Malay version of the questionnaire (SASC10-My TM ). The SASC10-My TM was then tested on 175 post-stroke patients who were recruited at ten public primary care health centres across Peninsular Malaysia, in a trial-within a trial study.Results One item from the original Dutch SASC19 (HomeSat) was dropped. Internal consistency for remaining 10 items was high (Cronbach alpha 0.830). Exploratory factor analysis showed the SASC10-My TM had 2 factors: discharge transition and social support services after discharge. The mean total score for SASC10-My TM was 10.74 (SD 7.33). Overall, only 18.2% were satisfied with outpatient stroke care services (SASC10-My TM score ≥ 20). Detailed analysis revealed only 10.9% of respondents were satisfied with discharge transition services, while only 40.9% were satisfied with support services after discharge.Conclusions The SASC10-My TM questionnaire is a reliable and valid tool to measure caregiver or patient satisfaction with outpatient stroke care services in the Malaysian healthcare setting. Studies linking discharge protocol patterns and satisfaction with outpatient stroke care services should be conducted to improve care delivery and longer-term outcomes.Trial registration: No.: ACTRN12616001322426 (Registration Date: 21st September 2016